Provider Demographics
NPI:1942269493
Name:LONGVIEW WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:LONGVIEW WELLNESS CENTER, INC
Other - Org Name:WELLNESS POINTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-758-2610
Mailing Address - Street 1:1107 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5602
Mailing Address - Country:US
Mailing Address - Phone:903-758-2610
Mailing Address - Fax:903-758-3124
Practice Address - Street 1:1107 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5602
Practice Address - Country:US
Practice Address - Phone:903-758-2610
Practice Address - Fax:903-758-3124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONGVIEW WELLNESS CENTER INC DBA WELLNESS POINTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-22
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110041041C0700X
TX191701223G0001X
207V00000X, 208000000X, 208D00000X, 261QF0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180330601Medicaid
TX111796203Medicaid
TX183824501Medicaid
TX081382602Medicaid
TX111796201Medicaid
TX111796204Medicaid
TX081382603Medicaid
TX111796204Medicaid
TX0092BVMedicare PIN